Provider Demographics
NPI:1477012102
Name:SCHUM, ALISA MARI (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:MARI
Last Name:SCHUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 12TH ST NE UNIT 1813
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4080
Mailing Address - Country:US
Mailing Address - Phone:256-289-3358
Mailing Address - Fax:
Practice Address - Street 1:800 MOUNT VERNON HWY NE STE 160
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4294
Practice Address - Country:US
Practice Address - Phone:770-709-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty